剖宫产产妇脊髓麻醉后保持左侧卧位6min对血压的影响分析

摘要

目的：探讨剖宫产产妇产前脊髓麻醉后保持左侧卧位6 min 对产妇血压的影响作用。方法采用随机数字表法将2011年7月至2014年3月收治的94例拟实施剖宫产产妇分为左侧卧位组（麻醉成功后保持左侧卧位6 min）和仰卧位组（麻醉成功后立即仰卧位）各47例，均为美国麻醉医师协会（Ⅰ~Ⅱ级），均采用腰麻硬膜外联合麻醉（CSEA）。比较两组患者麻醉前及最后不同时间的血压变化情况、最高镇痛平面、新生儿 Apgar 评分及不良反应等指标的差异。结果麻醉前左侧卧位组和仰卧位组产妇的基础收缩压（SBP）、舒张压（DBP）、心率（HR）值比较差异均无统计学意义（ P ﹥0.05），麻醉后3 min、麻醉后5 min、麻醉后10 min 仰卧位组产妇的 SBP、DBP 较麻醉前下降显著，HR 升高显著（ P ﹤0.05），而左侧卧位组产妇的 SBP、DBP、HR 值则比较稳定。左侧卧位组产妇的镇痛平面达到 T6的时间（8.61±1.32 min）显著长于仰卧位组产妇（7.28±1.04 min）；两组产妇的切皮至新生儿娩出时间、新生儿 Apgar 评分、脐动脉血 pH 值、脐动脉血 BE 值差异均无统计学意义（ P ﹥0.05）。左侧卧位组产妇的面色苍白发生率、恶心呕吐率、胸闷率、麻黄素使用率均显著的低于仰卧位组产妇（ P ﹤0.05）。结论剖宫产产妇产前脊髓麻醉后保持左侧卧位6 min 对产妇血流动力学、血压的稳定性有显著作用，同时可以降低术后不良反应率及麻黄素使用率。%Objective To investigate the influence on maternal blood pressure of cesarean section maternal prenatal after spinal anesthesia maintaining left lateral decubitus position 6min. Methods 94 cases of cesarean section were implemented into the left lateral decubitus position group(CSEA successfully keeping the left lateral position after 6 min)and 47 patients in supine groups using random number table from July 2011 to March 2014 were treated(supine position immediately after the successful CSEA). The diagnosis of all patients was consistent with the Ameri-can Society of Anesthesiologists(ASAⅠ ~ Ⅱ grade). All patients used the spinal epidural anesthesia(CSEA). The blood pressure at different times last changes,differences in analgesic highest plane,Apgar score,and adverse reactions and other indicators were compared between two groups of patients before anesthesia. Results SBP left lateral basis in anesthesia group and maternal supine group,DBP,HR value differences were not statistically significant( P ﹥ 0. 05). After anesthesia 3 min,after anesthesia 5 min,10 min after anesthesia maternal supine group,SBP and DBP decreased significantly compared with before anesthesia,HR increased significantly compared with before anesthesia( P ﹤ 0. 05). Ma-ternal SBP,DBP,HR value in the left lateral position group was relatively stable. Left lateral group of maternal analgesia time T6 plane reached 8. 61 ± 1. 32 min,which was significantly longer than the supine group of mothers of 7. 28 ± 1. 04 min. Two maternal incision time to neonates, neonatal Apgar scores,umbilical arterial pH,umbilical arterial BE values had the differences,which were not statistically significant( P ﹥0. 05). Pale incidence of maternal left lateral decubitus group,rate of nausea and vomiting,lightheadedness rate,ephedrine usage were significantly lower than the supine group mothers( P ﹤ 0. 05). Conclusion After cesarean maternal prenatal keeping left lateral spinal anesthesia 6min maternal hemodynamics,blood pressure stability has a distinct role,and can reduce postoperative adverse reaction rate and ephedrine usage.